Compared with uncircumcised men, circumcised men have accumulated larger numbers of STI in their lifetime, have higher rates of previous diagnosis of warts, and were more likely to have HIV infection. Results indicate that being circumcised predicted the likelihood of HIV infection."

ABSTRACT

Introduction. Circumcision among adult men has been widely promoted as a strategy to reduce human immunodeficiency virus (HIV) transmission risk. However, much of the available data derive from studies conducted in Africa, and there is as yet little research in the Caribbean region where sexual transmission is also a primary contributor to rapidly escalating HIV incidence.Aim. In an effort to fill the void of data from the Caribbean, the objective of this article is to compare history of sexually transmitted infections (STI) and HIV diagnosis in relation to circumcision status in a clinic-based sample of men in Puerto Rico.Methods. Data derive from an ongoing epidemiological study being conducted in a large STI/HIV prevention and treatment center in San Juan in which 660 men were randomly selected from the clinic's waiting room.Main Outcome Measures. We assessed the association between circumcision status and self-reported history of STI/HIV infection using logistic regressions to explore whether circumcision conferred protective benefit.Results. Almost a third (32.4%) of the men were circumcised (CM). Compared with uncircumcised (UC) men, CM have accumulated larger numbers of STI in their lifetime (CM = 73.4% vs. UC = 65.7%; P = 0.048), have higher rates of previous diagnosis of warts (CM = 18.8% vs. UC = 12.2%; P = 0.024), and were more likely to have HIV infection (CM = 43.0% vs. UC = 33.9%; P = 0.023). Results indicate that being CM predicted the likelihood of HIV infection (P value = 0.027).Conclusions. These analyses represent the first assessment of the association between circumcision and STI/HIV among men in the Caribbean. While preliminary, the data indicate that in and of itself, circumcision did not confer significant protective benefit against STI/HIV infection. Findings suggest the need to apply caution in the use of circumcision as an HIV prevention strategy, particularly in settings where more effective combinations of interventions have yet to be fully implemented.

Rodriguez-Diaz CE, Clatts MC, Jovet-Toledo GG, Vargas-Molina RL, Goldsamt LA, and García H. More than foreskin: Circumcision status, history of HIV/STI, and sexual risk in a clinic-based sample of men in Puerto Rico. J Sex Med

Maria VanderVliet

8/24/2012 05:23:09 am

I honestly find this a little troubling. One of the reasons we condemn the African study is that it relied on self-reporting. Its not ok to use a method we condemn from the opposition and green light it because we like the outcome better. I'm sure its no less accurate, but its also no slam dunk.

Becky T

9/16/2012 11:33:54 am

What troubles me besides the self reporting is the fact that there is no mention of how many partners each man was involved with. While I realize it only takes once to get an STD, the odds increase significantly with a higher number of different partners.

Will Sawyer

10/10/2012 06:01:05 am

As a Medical Statistician with over 20 years experience, I can share your concerns. I don't know what analysis methods they used (whether these are raw percentages, or adjusted ones) nor what other data they have for comparison of the CM and UCM groups. I can welcome this paper...if the analysis methods are poor, then it shows that poor analysis gives poor results and that this can be applied to previous studies, and if they are good, then the result shows what some of us have suspected for a long time.

roger desmoulins

2/21/2013 02:32:03 pm

I know of only one longitudinal study where all medical facts are based on medical records and clinical examinations. This study found no difference in STI incidence, up to age 32, between the 201 circed men and 298 intact men.
http://www.ncbi.nlm.nih.gov/pubmed/18280846

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Michelle

4/8/2013 12:46:02 am

I just viewed this video and found it mind-blowing. There is much money to be made from the whole HIV/AIDS hype, which is completely overcharged and overblown. We need to focus on providing the basics of healthy food, clean water, medical care, etc. Wasting money on circumcision in these countries is ridiculous. Thank you for this link!!

Tom

2/20/2013 01:53:02 pm

Circumcision is sexual torture, those advocating it and the doctors performing it on a helpless minor should be tried criminally.

ntsako ngobeni

8/25/2013 04:03:05 am

the cure is the but they won`t revel it since HIV is make allot of money for the companies that produces Nivarapine and it is another way to limit human population on earth since we are getting over croweded

John Smith

8/25/2013 10:40:17 pm

Those studies should take more factors into account, namely:
1. The correlation between circumcision and sexual behaviors (both amount and in terms of practice) caused by a lowered sexual reward due to insensitivity of the glans
2. The correlation between circumcision due to religion and social inclinations. Namely if the pool of sexual partners is due to religious or even just reward-seeking reasons shifted or expanded towards or away from more promiscuous partners who are already more likely to contract STD.

Those aspects could possibly explain the discrepancy between this study and the African studies.

That is that for example circumcision may actually increase STD risks biologically due to lower skin mobility, skin resistance, scarring and consequently more damage to it during intercourse resulting in, in an easier transmission of pathogens. In combination with that, people in the Caribbean might have lower sex drives, therefore a less requited reward-seeking behavior due to circumcision might not be as statistically significant. In combination with that, they might not share the same religious or social motivations towards circumcision, hence have sex with essentially the same pool of people that uncircumcised men do, resulting again in less bias within the statistics.

Considering the marginally protective effect of circumcision (1 less in 72 cases) those marginal factors might as well cause the claimed statistical bias.